Tuesday, September 30, 2014

As we know, trauma increases blood flow to the amygdala while
decreasing perfusion to the hippocampus with the effect that procedural,
emotional and sensory memory take place without the benefit of symbolization
in language and without contextualization (one physiological explanation for
dissociation). This phenomenon informs how clinicians can work with experience that has no words. The narrative approach assumes that symbolization is already present. Trauma, including the trauma of chronic misattunement, can cause chronic autonomic
nervous system activation (affecting respiration, heart rate, perspiration,
muscle tension, etc) with its emphasis on sensory not symbolic representation.

Bucci proposed a multiple code theory of emotional processing,
three systems of emotional schema: the subsymbolic
(perceptual, sensory), symbolic imagery
– both non-verbal— and the symbolic
(verbal). These three systems are
separate, but through the relational attunement and secure attachment with
caregivers, who use their own emotional and cognitive schema to help children name,
accept and regulate their emotional states, connections between the three are
forged. In somatization, subsymbolic somatic schema are activated but are dissociated,
never linked, or have lost their link to symbolic representations.

Taylor contrasts conversion disorder with somatization
disorders. In the former, symbolization is intact and emotions are represented,
and symptoms are the result of repressed (by an active ego), conflictual
fantasies. On the other hand, somatization, writes Taylor, lacks underlying
fantasies, and emotions are poorly representable, sometimes called alexithymia.
(The ego is made helpless by dissociation.) Two different therapeutic aims
ensue. For conversion symptoms, Freud made conscious the unconscious conflict through
interpretation, but with somatization symptoms, says Bucci, what is required is
a strengthening of connections between the subsymbolic and symbolic.

Gottlieb gives a nice history of the way different psychoanalysts
have conceived of psychosomatic symptoms. They argue causality, meaning, and treatment.
Students might enjoy contrasting Janet, Freud and MacDougall, as well as distinguishing
la pensee operatoire from alexithymia. Many agree that somatization involves
dissociation. Where does a child turn when the very people who are to help regulate
distressing feelings are also their source? Hopefully, we will, in class, add
from our clinical experience the relational intersubjective component of psychosomatic
disorders, with the understanding that caregivers powerfully affect one’s
ability to symbolize, mentalize, and see the other as an equal center of
subjectivity.

Monday, September 29, 2014

Winnicott and Knox both speak to the infant’s developing
sense of self and both are relational in the import for this ascribed to the
environment. Winnicott wrote that
only in play, being creative, can the individual discover [become] the self. Being
creative is not about products of the body or mind, but rather a feature of
total living. Play, for Winnicott, meant living in the potential space [sometimes
called transitional space or the third], “an area that is intermediate between
the inner reality of the individual and the shared reality of the world that is
external…” Winnicott exhorts the therapist to create an environment which
allows for this third space in which to play. The good enough therapist
provides repeated experiences that allow the patient to trust as well as enters
into the arena of play with the patient.

While Winnicott recommends refraining from getting in the
patient’s way to self discovery, for example, by the therapist being more
interested in being clever, the one who knows or makes sense of, than in
following the patient’s formlessness, his example seems to belie that his
patient came alive from her formlessness (and his restraint from
interpretation). Instead, she seems to complain repeatedly that she did not
matter to him and only became enlivened after
he actually shared the contents of his mind with her. [The mother develops her baby’s mind, and co-creates meaning,by having him in her mind, and by engaging the infant in reciprocal turn-taking.] It was when
Winnicott reflects back, nearly two hours later, his patient’s experience to her does her experience
take on meaning for her. [It befuddles me how Kohut failed to cite Winnicott when writing about mirroring.]

Knox writes that the infant’s sense of self first comes in to being by the meaning attributed to its actions by its mother. A child internalizes [develops its sense of self through] its mother’s attributions, positive or negative. Negative attributions, internalized, then, can generate a sense of a deficient self, with its concomitant shame. To bulwark a diminished self, grandiosity and narcissism may be self-protective as the child struggles to remain alive emotionally.

Wednesday, September 24, 2014

Today The United Nations Security Council resolved
unanimously to stem the flow of foreign terrorist fighters across borders, allowing Secretary General Ban Ki-Moon, in his address to the Council, to note how “enemies of
faith…brutalize women and girls” and “target and slaughter minorities.” He also said, “Eliminating terrorism
requires international solidarity …[W]e must also tackle the underlying
conditions…The biggest threat to
terrorists is not the power of missiles. It is the politics of inclusion…and
respect for human rights…Missiles may
kill terrorists, but good governance kills terrorism…societies… free from
suffering, oppression and occupation.”

And Melinda Gates highlighted the pressing need for gender
equality (e.g. in education and health) around the world. [Despite the gender
inequality unaddressed] in the Civil Rights movement, the tenet that ‘no one is
free until we are all free’ still rings
true, and women and girls have waited a long time for equality. Perhaps the wait is approaching closer its end.

Monday, September 22, 2014

Scott Ferguson, PhD, Film Professor at USF, spoke to the
“pleasure” of horror films—indulging viscerally, sensually-perceptually, and
affectively in the “abject”— and about the pleasures and horrors of media.
Evoking Marshall McLuhan, he noted that egalitarian access to information media
destabilized roles and place, frightening some, while simultaneously allowing
new freedoms for connections. How are we to negotiate being with one another in
these new ways, all the while uncertain, our privacy threatened? There are
ethical challenges to consider [and only Aidan pauses to ask about how our
choices affect others].

Ferguson asked us to consider how a film engages the
cultural moment, socially and historically, not merely to think psychologically
about relationships and characters, but to additionally think about how these
are also conditioned by electronic media. The winged shape of a ‘samara’ seed enables
the wind to carry it farther away from the parent tree. Thus estranged from its
origins, Samara – adopted, then killed, then killer— speaks to the futility of
recapturing the nuclear family, if one ever existed.

Symbols in this film confound the viewer, first
suggested, then disconfirmed, offered, then undermined. There is the ring left
by a coffee cup or that formed by the mouth of the well, Samara’s tomb, and, of
course, the fatal telephone ring. A ring can symbolize wholeness, closure,
where beginning and end meet, but in this film there is no resolution. A
lighthouse which is meant to give protective warning, leads to more danger. The
island isolates and connects. Where medium is viewed as conduit, agency, means,
The Ring depicts multi-media:
telephones, boats, water.

Much was made of reproduction, whether the copying of
the VHS tape or human procreation, both leading, in this film, to a deadly
end. One audience member asked why do humans seek to procreate, particularly
when children are so disruptive to their parents’ lives. Anna kills her adopted
daughter Samara. Thinking about the
relational context depicted in the film, how are the children allowed to
develop and then engage the world? Neither Samara nor Aidan were wanted by
their fathers, Richard and Noah, respectively. Despite the exterior trappings
of a normal home, there was no space for Samara to be herself. Samara was a
child wanting to be heard, calling out to be saved. Her adoptive parents
constrained her, not just in the barn, but in every way. Samara’s agency frightened her parents. She
had to produce herself, come in to being herself. Parents who disempower their
children, dehumanize them, creating monsters.

The audience also appreciated the cinematography,
comparing its chaotic black and white scenes to Picasso’s Cuernavaca, the isolation of the island buildings to Hopper, and
the grayish-greenish imagery to our surreal nightmares. At other scenes, color was hyper-saturated, like neon invading our senses.

So many perspectives brought together, what a rich
discussion followed the viewing of The
Ring yesterday!

Saturday, September 20, 2014

The 2014-15 Film Series “Return of the Repressed” (horror
films) opens Sunday,
September 21, with The Ring
(2002), directed by Gore Verbinski, and discussed by USF Film Professor Scott
Ferguson, PhD, and myself. The Film Series is a
collaboration between the Tampa Bay Institute for Psychoanalytic Studies and the Tampa Bay Psychoanalytic Society. I am no fan of horror films, but I will
discuss at the film’s showing how The
Ring, [as does Case 39, to be
shown on Feb. 15, 2015] exemplifies our fear of our children. Scott, I think, will be discussing our fear of
technology.

Because an infant’s sense of self first comes in to being
by the meaning attributed to its actions by its mother, a child is vulnerable
to its mother’s negative attributions. If she sees his hunger as greedy, or his
natural exuberance as evil, the infant senses her disapproval and rejection. [I
once heard a mother attribute her infant son’s fists to his wish to assault
her. The ‘fists’ of a baby are consequent of the grasp reflex, with which all healthy
infants are born--perhaps left over from our more furry ancestors clinging to
their mothers’ backs.] These negative attributions are internalized and are
thought to become part of one’s sense of self (in the cortical and subcortical
midline systems via connections to the insula. Mirror neurons in the insula are triggered
when one observes disgust on another’s face. )

When mothers are unable to regulate their own distress,
the distress of their infants becomes unmanageable. Depressed mothers ‘shut down,’ turn away, or ‘close’
their faces to their infants. [We are told in The Ring, that Anna was unable to carry her own biological child
and was institutionalized.]

Mothers who eschew their children’s strivings convey that
the child’s agency is unacceptable. Should a parent’s repressed or dissociated
(disavowed) fears and impulses be unconsciously projected onto their children,
the child becomes ashamed of himself, his impulses, and his agency. He sees
himself as bad, destructive, unlovable. [Perhaps Samara is living out what her
adoptive parents saw in her, that which was disavowed in themselves.]

We hope that local readers will join us Sunday, Sept 21
at 2pm. Here is the entire series roster:

the 2014-2015 Film Series

Horror films: “Return of the Repressed”

Psychoanalysis is interested in art, such as film,
because it assumes two levels of meaning, one manifest, the other hidden. It is
the latter unconscious meaning which resonates with the viewer. Horror films,
in particular, express the Freudian motivations (drives), and the fear of
aggression and libido, which are often communicated in symbols. Some say it is
these unconscious motivations, threatening to become manifest, which terrorize
us, including the fear of the discovery of the unknown, whether it be the
monster lurking in the shadows or in the unconscious. What contemporary analysts
understand to be more horrific, though, is loss of connection and meaning, when
one finds oneself utterly devoid of embeddedness and place.

Tuesday, September 16, 2014

The body remembers. Early traumatic experience, whether
occurring before the hippocampus comes ‘on-line’ or dissociated from symbolism
by decreased blood flow to the otherwise functioning hippocampus, is
procedurally ‘learned’ and stored by affect and perceptual senses. Chronic
thigh pain may be the only link to the pain of childhood sexual abuse, the
smell of a particular cologne and its consequent headaches the only connection
to herald long ago parental tirades. We
feel. We panic. We don’t remember the events. It may take countless hours of
psychotherapy before integration and words allow voice to be given to those
early threats to sense of self.

In Theaters of the
Body (1989) Joyce MacDougall writes that psychosomatic illness results from
the body reacting to a psychological threat as though it were a physical threat
due to lack of awareness of our emotional states when being threatened, so
seeking psychological treatment is very tricky for both patient and therapist.
While one may wish to be free of psychological (and psychosomatic) symptoms, we
must remember that these symptoms have been, since childhood, a best possible
attempt at bearing the unbearable. Our patients wish and fear the giving up of
these symptoms for these symptoms helped (in earlier times) with psychic
survival. They may also be the only clues we have to early traumas.

Kradin, from a Jungian perspective, provides an
introduction to the psychosomatic illnesses. He states that the psychosomatic
symptom is “a symbolic communication by the suffering self to caregivers…a cry for help in hope that someone will
respond, and a method of repelling others as an expression of unconscious
dread.” Early caregivers regulate infant distress and give meaning to infants’
bodily sensations. The failure of symbol formation in people suffering with
psychosomatic disorders speaks, in part, to the inadequate regulation between
mother and infant. Kradin highlights (from Noyes) the anxious maladaptive
attachment style where (from Driver) etiology of at least one disorder, CFS, is
speculated to include “inadequately internalized maternal reflective function,
affect dysregulation, and diminished psyche-soma [Winnicott] differentiation.”
Other events often found in the histories of patients with psychosomatic disorders
are “a parent with physical illness, a history of family secrets, and childhood
maltreatment” including emotional abuse. Kradin reminds therapists that our aim
is treatment of the disordered self and
not symptom reduction. “[S]ymptoms are ‘real’, whatever their cause” and
“healing begins only once caregivers have disabused themselves of the notion
that patients are responsible for their disease.”

Monday, September 15, 2014

1.For Auerbach a narcissistic individual, in
contrast, the self is experienced as cohesive and vital at the cost of the object's becoming
fragmented and lifeless,and vice versa. That is why one who has capacity for
self-love can love others,and why narcissistic individuals are profoundly invested
in others but only insofar as others are mirroring them or are capable of
being idealized. Terms like part object, selfobject, and transitional object
express the narcissistic patient's representational and relational difficulties.

2. Auerabach using
a Piagetian framework according to Bach, states that narcissistic patients have difficulty in establishing
equilibrium between subjective awareness (i.e., the immediate, nonreflective
immersion in the experience of self as a center of thought, feeling, and
action) and objective self-awareness (i.e., the awareness of self, including
thoughts, experiences, feelings, actions, etc., as an object among other objects
and a self among other selves).

3. Auerbach states
that shame is a core issue in the effort to understand narcissism. "that shame is an ineluctable
consequence of objective self-awareness, and that objective self-awareness, the eye
turned inward to discover in the midst of interest or enjoyment hidden
faults and defects, is the core of shame.

4. Shame emerges,
in this second perspective, as the mediating term in the dialectic of subjective and objective self-awareness but
at the same time is also at the core of the resistance to psychoanalytic
psychotherapy and psychoanalysis by containing a desire not to be exposed.

5. Psychological health, adequate self-esteem, involves
not an absence of shame but a capacity to tolerate the shame that inheres in
individuality. In other words, shame ensures that selfhood, no matter how well
established, always remains a locus of conflict.

6. Bach notes, provide alternative but illuminating
developmental perspectives on this narcissistic dilemma, and suggest that
narcissistic disturbance involves not so much a misallocation of libido as a problem in the
representation of objects and object relations.

7. Subjective awareness, as I call it, is a state in
which we are totally into ourselves and our feelings while the rest of the world is
in the background—that is, a Romantic or Dionysian state of mind.

8. For Bach we are all both Dionysians and Apollonians,
Romantics and Classicists, but one difference lies in our preferred
mode of being and also in our abilities to make the transition or oscillate back
and forth, flexibly and appropriately, between these two states.

9. For Bach there
are 2 types of narcissism: the inflated sadistic type who presents with open grandiosity and an unconscious sense
of worthlessness and the deflated masochistic type who presents with open
feelings of worthlessness and an unconscious sense of grandiosity.
The inflated type with open grandiosity exists primarily in a state of
subjectivity, concerned only with himself and unable to be objective about his
aspirations, but unconsciously he feels worthless and self-critical. The
deflated type with open feelings of worthlessness exists primarily in a
state of objective self-

awareness, masochistically denigrating and criticizing
himself as if he were some hostile outside observer, but unconsciously he may
feel quite special or grandiose.

10. But, what occurs as the child matures is not just
better regulated and more appropriate oscillations between subjectivity and
objectivity or between self and other but rather a more complex
synthesis, a blending and interpenetration of the two in the transitional area so
that they are no longer simply dichotomous.

Sunday, September 14, 2014

It was fortuitous to have had John Auerbach, PhD in Tampa
yesterday speaking at the local (Tampa Bay) Psychoanalytic Society, for the
Institute begins its Fall Semester this week and we are reading on Wednesday, in
the Narcissism and Shame course, a review by Auerbach. Speaking to Bach’s ideas
on the subject, Auerbach highlights the disruption of reflective self-awareness
in those with narcissistic disturbances.

Bach tells us that the grandiose, inflated narcissist
exists in a state of subjectivity (increased subjective awareness, ‘it’s all about
me’), with the sense of worthlessness in the background. Subjective self-awareness
alternates with objective self awareness in which the narcissist denigrates the
self, feeling deflated and worthless. Auerbach notes the paradox of these two
states of reflective self-awareness: “subjective awareness increases the sense
of aliveness but decreases objective knowledge of self, and objective self-awareness,
by increasing knowledge of one’s place (and smallness) in the world, decreases
self esteem.” This very paradox is what causes in the narcissist fragmentation
of the sense of self. Interpretation (of,
for example, the difficulty) is experienced “as an attack upon the self, a
narcissistic injury.” Instead, the transitional space between objective and
subjective can be utilized to develop and maintain self cohesion.

Self reflection is the ability to view oneself as if looking
on (objectively) from the outside. Bach notes two states of self awareness: subjective
and objective, and how difficult it is to move easily between them if early
caregivers did not help regulate the transition between them smoothly enough to
prevent abrupt shifts in autonomic and limbic systems’ firing. Auerbach, too,
in his review of Nathanson’s The Many
Faces of Shame, tells us that sudden interruption of excitement or joy can
induce shame, the hallmark affect of narcissism, and Auerbach writes, “shame is
the ineluctable consequence of objective self awareness…” And isn’t that what psychoanalytic therapy partly
endeavors to do, to increase objective self-awareness, all the while inadvertently
engendering shame? This semester, we endeavor to discuss how to minimize shame
in our patients and ourselves as we struggle to become.

Welcome!

Welcome to "Contemporary Psychoanalytic Musings," the blog of the Tampa Bay Institute for Psychoanalytic Studiesor, as it is conveniently known, T-BIPS. We invite you to post your comments on psychoanalysis and books, film, conferences, the media, art, theory, clinical situations, current controversies, social issues, and anything else as seen through a psychoanalytic lens. We look forward to a spirited dialogue with you.Lycia Alexander-Guerra, M.D.TBIPS PresidentGabcast! Welcome! #3

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In 2005 a group of psychoanalysts & psychoanalytic psychotherapists convened to explore possibilities for meeting the educational needs of clinical professionals in the Tampa Bay area. Out of those discussions evolved a new institute, the Tampa Bay Institute for Psychoanalytic Studies. Consistent with the spirit of collegiality, openness, and diversity that inspired its development, the new Institute is non-authoritarian and democratic. Training programs utilize progressive and classical concepts which have been endorsed by contemporary critiques of psychoanalytic education. Believing that the capacity to think psychoanalytically best develops in an atmosphere of inquiry, open dialogue, and active participation the founding members sought to integrate these values into the structure of the new Institute and into the process of training. A precedent of collaboration and mutual respect for the contributions of all faculty and candidates was established enabling our mission to gain immediate representation in our actions.